Special training of patients’ attendants can reduce incidence

Simple training imparted to the loved ones and relatives of bed-ridden patients suffering from paralysis can lead to a significant decline in the incidence of pressure sores, reveals a study carried out by the neurosurgery department of the Pakistan Institute of Medical Sciences (PIMS).

The study, which was conducted by Dr. Shaukat Dar and Dr. Ehsan — both of them residents in the department of neurosurgery — was presented at a seminar held in connection with the PIMS Annual Symposium 2008.

The paucity of nursing staff in the neurosurgery department of PIMS provided the impetus for carrying out the study. The study found that simple training imparted to attendants, relatives and caregivers can lead to a marked decline in the number of patients who end up developing irreversible bedsores. The department trained attendants to provide mouth, skin and nutritional care; and to perform simple physiotherapy of unconscious patients who had sustained serious head injuries. Of the 1,377 patients studied over two years and treated for a period of 1-3 months, only 28 patients (2 per cent of the patients studied) developed pressure sores. A majority of these patients were paralysed by cervical injury and their attendants were trained on how to turn their sides while on bed.

“It only requires two nurses to train attendants. Rather than complaining of shortage of nurses, we need to learn how to best handle patients within whatever resources and expertise is available at hand,” Dr. Ehsan pointed out. Had it not been for the care provided by the relatives and loved ones of the patients, they would have had to endure additional agony. “All healthcare centres facing paucity of nursing staff can follow this approach to reduce the suffering of patients,” he added.

Another study conducted by neurosurgery resident Dr. Waseem Anwar found that one tablet of folic acid taken every day by women of child-bearing age can lead to a decline in the number of children born with Meningomyelocoele, a condition in which children remain crippled for life; have no control over urine and faeces; and have a swelling on the back. While Canada barely reports one case of Meningomyelocoele per year, the incidence in Pakistan is much higher. PIMS alone receives 3 to 4 cases of Meningomyelocoele per week.

Dr. Waseem informed that 100 tablets of folic acid cost Rs12 only, rendering it within the reach of every Pakistani. The real challenge is lack of awareness. “We need to fortify our bread and flour with folic acid to reduce the incidence of Meningomyelocoele,” Dr. Waseem said. Some of the participants believed that unless such a child is born to an influential family, there is little hope for any action being taken in this neglected area.

The audience was informed that Meningomyelocoele results from malnourishment, use of some epileptic medicines, cousin marriages, and the damaging effects of X-rays in women who are not sure their pregnancy. Since the brain of a child develops in 30 days, early X-rays can have a damaging impact. The study also found that even in cases where ultrasounds, medicines and antenatal care were provided, accurate diagnosis was missing.

Dr. Khaleeq-uz-Zaman focused on how innovation can help save lives in a hospital setting constrained by shortage of equipment and staff. “The brain is the biggest technology. If the objective is to save lives, lives can be saved through appropriate use of the brain,” he remarked. The neurosurgeon said, leadership ownership, commitment, and innovation must be the hallmark of all doctors. He advised doctors to foster team spirit and to learn to work within given constraints. “No doctor can have an excuse for not providing first aid and supporting a critical patient within the first golden hour,” he said. Dr. Khaleeq said every patient should be treated like a VIP.

Dr. Samina Khaleeq talked about the management of unidentified patients with severe head injuries. She referred to a study carried out on 91 unconscious patients who were brought to the department of the neurosurgery over the period of 7 years. The study found that the mortality and morbidity of unaccompanied patients was comparable to the mortality and morbidity ratios of those accompanied by their relatives, meaning that unaccompanied patients were managed just as well. The patients were also provided medicines and surgical disposables from funds raised by the department of the neurosurgery from its own recourses.

Other speakers included Prof. Iqbal of Islamic International Medical College, who gave a detailed description of an ideal emergency and trauma centre; pulmonologist Dr. Kosar Rehana, Prof. Ghazala Mehmood, Dr. Hameed-ud-Din, critical care specialist. Dr. Vincent Ioos, Dr. Lubna Naseem, and Dr. Shagufta Hussain.

Prof. Muhammad Umer, chief of gastroenterology and hepatology unit of Holy Family Hospital said that a PC-1 for Liver Transplant has been approved by the cabinet. He said, liver transplant would be possible at Sheikh Zaid Hospital, Lahore, within 1-2 years. Of the 10 million patients of Hepatitis B and C in Pakistan, 10 per cent need liver transplantation. Prof. Nadeem Ahmed, consultant surgeon, PIMS, announced to launch a Liver Transplant Society. He said that the rising incidence of Hepatitis in Pakistan makes it imperative to have more transplant surgeons and more specialised liver transplant units in all big cities.